Journal Article

Large-scale Artemisinin-Piperaquine Mass Drug Administration With or Without Primaquine Dramatically Reduces Malaria in a Highly Endemic Region of Africa

Xu, Qin, Zhang, Hongying, Yang, Tao, Su, Xin-zhuan, Tuo, Fei, Bacar, Affane, Huang, Shiguang, Wang, Xinhua, Oithik, Fatihou, Liu, Xiao-hong, Feng, Danghong, Kéké, Rachadi A, Yan, Hong, Deng, Changsheng, Zhou, Jiuyao, Li, Xiao-bo, Zheng, Shaoqin, Lu, Fangli, Mohadji, Fouad, Lin, Li, Song, Jianping, Mohamed, Moussa, Fay, Michael P, Wellems, Thomas E, Huang, Bo, Xue, Linlu, Wang, Qi, Li, Guoming, Said Abdallah, Kamal, Wu, Zhibing, Wu, Wanting, Li, Di, Msa Mliva, Ahamada

2018

Overview

Does adding low-dose primaquine to mass drug administration of artemisinin-based combination therapy improve malaria control? On a highly endemic African island, >99% effectiveness of falciparum malaria reduction followed 3 monthly rounds of artemisinin and piperaquine, with or without low-dose primaquine. Abstract Background Mass drug administration (MDA), with or without low-dose primaquine (PMQLD), is being considered for malaria elimination programs. The potential of PMQLD to block malaria transmission by mosquitoes must be balanced against liabilities of its use. Methods Artemisinin-piperaquine (AP), with or without PMQLD, was administered in 3 monthly rounds across Anjouan Island, Union of Comoros. Plasmodium falciparum malaria rates, mortality, parasitemias, adverse events, and PfK13 Kelch-propeller gene polymorphisms were evaluated. Results Coverage of 85 to 93% of the Anjouan population was achieved with AP plus PMQLD (AP+PMQLD) in 2 districts (population 97164) and with AP alone in 5 districts (224471). Between the months of April-September in both 2012 and 2013, average monthly malaria hospital rates per 100000 people fell from 310.8 to 2.06 in the AP+PMQLD population (ratio 2.06/310.8 = 0.66%; 95% CI: 0.02%, 3.62%; P = .00007) and from 412.1 to 2.60 in the AP population (ratio 0.63%; 95% CI: 0.11%, 1.93%; P < .00001). Effectiveness of AP+PMQLD was 0.9908 (95% CI: 0.9053, 0.9991), while effectiveness of AP alone was 0.9913 (95% CI: 0.9657, 0.9978). Both regimens were well tolerated, without severe adverse events. Analysis of 52 malaria samples after MDA showed no evidence for selection of PfK13 Kelch-propeller mutations. Conclusions Steep reductions of malaria cases were achieved by 3 monthly rounds of either AP+PMQLD or AP alone, suggesting potential for highly successful MDA without PMQLD in epidemiological settings such as those on Anjouan. A major challenge is to sustain and expand the public health benefits of malaria reductions by MDA.

• Publisher: Oxford University Press
• Subject: Adolescent / Adult / and Commentaries / Antimalarials - therapeutic use / Artemisinins - therapeutic use / Child / Child, Preschool / Comoros - epidemiology / DNA, Protozoan - genetics / Drug Therapy, Combination / Endemic Diseases - prevention & control / Female / Humans / Infant / Malaria, Falciparum - epidemiology / Malaria, Falciparum - mortality / Malaria, Falciparum - prevention & control / Male / Mass Drug Administration / Parasitemia - drug therapy / Parasitemia - epidemiology / Plasmodium falciparum / Polymorphism, Genetic / Primaquine - therapeutic use / Quinolines - therapeutic use / Treatment Outcome / Young Adult